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Wezynfeld NE, Sudzik D, Tobolska A, Makarova K, Stefaniak E, Frączyk T, Wawrzyniak UE, Bal W. The Angiotensin Metabolite His-Leu Is a Strong Copper Chelator Forming Highly Redox Active Species. Inorg Chem 2024; 63:12268-12280. [PMID: 38877980 PMCID: PMC11220758 DOI: 10.1021/acs.inorgchem.4c01640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 07/02/2024]
Abstract
His-Leu is a hydrolytic byproduct of angiotensin metabolism, whose concentration in the bloodstream could be at least micromolar. This encouraged us to investigate its Cu(II) binding properties and the concomitant redox reactivity. The Cu(II) binding constants were derived from isothermal titration calorimetry and potentiometry, while identities and structures of complexes were obtained from ultraviolet-visible, circular dichroism, and room-temperature electronic paramagnetic resonance spectroscopies. Four types of Cu(II)/His-Leu complexes were detected. The histamine-like complexes prevail at low pH. At neutral and mildly alkaline pH and low Cu(II):His-Leu ratios, they are superseded by diglycine-like complexes involving the deprotonated peptide nitrogen. At His-Leu:Cu(II) ratios of ≥2, bis-complexes are formed instead. Above pH 10.5, a diglycine-like complex containing the equatorially coordinated hydroxyl group predominates at all ratios tested. Cu(II)/His-Leu complexes are also strongly redox active, as demonstrated by voltammetric studies and the ascorbate oxidation assay. Finally, numeric competition simulations with human serum albumin, glycyl-histydyl-lysine, and histidine revealed that His-Leu might be a part of the low-molecular weight Cu(II) pool in blood if its abundance is >10 μM. These results yield further questions, such as the biological relevance of ternary complexes containing His-Leu.
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Affiliation(s)
- Nina E. Wezynfeld
- Chair of
Medical Biotechnology, Faculty of Chemistry, Warsaw University of Technology, Noakowskiego 3, 00-664 Warsaw, Poland
| | - Dobromiła Sudzik
- Institute
of Biochemistry and Biophysics, Polish Academy
of Sciences, Pawińskiego 5a, 02-106 Warsaw, Poland
| | - Aleksandra Tobolska
- Chair of
Medical Biotechnology, Faculty of Chemistry, Warsaw University of Technology, Noakowskiego 3, 00-664 Warsaw, Poland
| | - Katerina Makarova
- Institute
of Biochemistry and Biophysics, Polish Academy
of Sciences, Pawińskiego 5a, 02-106 Warsaw, Poland
- Department
of Organic and Physical Chemistry, Faculty
of Pharmacy, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
| | - Ewelina Stefaniak
- Institute
of Biochemistry and Biophysics, Polish Academy
of Sciences, Pawińskiego 5a, 02-106 Warsaw, Poland
- National
Heart and Lung Institute, Imperial College
London, Molecular Sciences
Research Hub, London W12
0BZ, United Kingdom
| | - Tomasz Frączyk
- Institute
of Biochemistry and Biophysics, Polish Academy
of Sciences, Pawińskiego 5a, 02-106 Warsaw, Poland
| | - Urszula E. Wawrzyniak
- Chair of
Medical Biotechnology, Faculty of Chemistry, Warsaw University of Technology, Noakowskiego 3, 00-664 Warsaw, Poland
| | - Wojciech Bal
- Institute
of Biochemistry and Biophysics, Polish Academy
of Sciences, Pawińskiego 5a, 02-106 Warsaw, Poland
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Qin TX, Yao YT. Vasoplegic syndrome in patients undergoing heart transplantation. Front Surg 2023; 10:1114438. [PMID: 36860952 PMCID: PMC9968842 DOI: 10.3389/fsurg.2023.1114438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/11/2023] [Indexed: 02/16/2023] Open
Abstract
Objectives To summarize the risk factors, onset time, and treatment of vasoplegic syndrome in patients undergoing heart transplantation. Methods The PubMed, OVID, CNKI, VIP, and WANFANG databases were searched using the terms "vasoplegic syndrome," "vasoplegia," "vasodilatory shock," and "heart transplant*," to identify eligible studies. Data on patient characteristics, vasoplegic syndrome manifestation, perioperative management, and clinical outcomes were extracted and analyzed. Results Nine studies enrolling 12 patients (aged from 7 to 69 years) were included. Nine (75%) patients had nonischemic cardiomyopathy, and three (25%) patients had ischemic cardiomyopathy. The onset time of vasoplegic syndrome varied from intraoperatively to 2 weeks postoperatively. Nine (75%) patients developed various complications. All patients were insensitive to vasoactive agents. Conclusions Vasoplegic syndrome can occur at any time during the perioperative period of heart tranplantation, especially after the discontinuation of bypass. Methylene blue, angiotensin II, ascorbic acid, and hydroxocobalamin have been used to treat refractory vasoplegic syndrome.
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Affiliation(s)
- Tong-xin Qin
- Department of Anesthesiology, Shanxian Central Hospital, Heze, China
| | - Yun-tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China,Correspondence: Qin T-x, Yao Y-t
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Rodriguez R, Fernandez EM. Role of angiotensin II in treatment of refractory distributive shock. Am J Health Syst Pharm 2020; 76:101-107. [PMID: 31361800 DOI: 10.1093/ajhp/zxy014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Clinical data and gaps in knowledge regarding angiotensin II (AT2), which was approved by the Food and Drug Administration in December 2017 via priority review for treatment of septic and other vasodilatory shock, is discussed. SUMMARY AT2 is an endogenous peptide that raises blood pressure via vasoconstriction and increased aldosterone release. It was previously available but withdrawn from the US market; previous low-quality research describes increases in mean arterial pressure (MAP). The recent approval of AT2 was based on data from a Phase III randomized trial comparing i.v. AT2 (n = 163) with placebo use (n = 158) in patients with vasodilatory shock receiving high doses of other vasopressors. AT2 significantly increased achievement of the primary endpoint, MAP response at 3 hours after the start of infusion, relative to placebo use (69.9% [n = 114] versus 23.4% [n = 37], p < 0.0001). Serious adverse events occurred in 60.7% (n = 99) and 67.1% (n = 106) of patients treated with AT2 and placebo recipients, respectively, including venous and arterial thromboembolic events (12.9% [n = 21] and 5.1% [n = 8], respectively). No significant effects of AT2 on 7- or 28-day mortality were seen among all patients in the ATHOS-3 trial. However, post hoc analyses suggested that AT2 may reduce mortality in patients with low baseline AT2 levels, exaggerated response to AT2, and acute kidney injury receiving concomitant renal replacement therapy. Overall, due to shortcomings of the ATHOS-3 trial data and the absence of confirmatory studies, the optimal place in therapy of AT2 for vasodilatory shock cannot be determined with confidence. CONCLUSION Intravenous AT2 represents a novel treatment strategy for refractory septic or other vasodilatory shock, although findings of safety and efficacy have not been replicated and the drug's optimal place in therapy is uncertain.
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Affiliation(s)
- Ryan Rodriguez
- Drug Information Group, University of Illinois at Chicago College of Pharmacy, Chicago, IL
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Wieruszewski PM, Radosevich MA, Kashani KB, Daly RC, Wittwer ED. Synthetic Human Angiotensin II for Postcardiopulmonary Bypass Vasoplegic Shock. J Cardiothorac Vasc Anesth 2019; 33:3080-3084. [DOI: 10.1053/j.jvca.2019.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 01/11/2023]
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Angiotensin II: A New Vasopressor for the Treatment of Distributive Shock. Clin Ther 2019; 41:2594-2610. [PMID: 31668356 DOI: 10.1016/j.clinthera.2019.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE Angiotensin II (ATII) is a potent endogenous vasoconstrictor that has recently garnered regulatory approval for the treatment of distributive shock, including septic shock. Traditional vasoactive substances used in the management of distributive shock include norepinephrine, epinephrine, phenylephrine, and vasopressin. However, their use can be associated with deleterious adverse drug effects, such as splanchnic vasoconstriction and associated hypoperfusion. The purpose of this review is to describe ATII, including its pharmacologic mechanisms, pharmacokinetic profile, evidence of efficacy and tolerability, and potential role in contemporary critical care practice. METHODS Peer-reviewed clinical trials and relevant treatment guidelines published from 1966 to September 14, 2019, were identified from Medline/PubMed using the following search terms: angiotensin II OR angiotensin 2 AND shock OR septic shock OR vasodilatory shock. Pertinent review articles were reviewed for additional studies for inclusion and discussion. The final decision on the inclusion of studies in the current review was based on the expert opinion of the authors. FINDINGS On the basis of the available evidence, ATII is effective at elevating blood pressure in patients with distributive shock and appears to reduce the dose of concurrent vasopressors to maintain adequate blood pressure. ATII has been investigated for other causes of shock; however, robust evidence of off-label indications is lacking and is much needed. Clinical and cost benefits compared with traditional vasopressors have yet to be established. IMPLICATIONS ATII represents a welcome addition to the armamentarium of critical care clinicians. Enthusiasm for the use of ATII should be balanced with the current gaps in our understanding of ATII in patients with shock. Until further evidence provides more clinically meaningful benefits, as well as cost-effectiveness compared with currently available vasopressors, critical care clinicians should reserve ATII for salvage therapy in patients with septic shock.
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Gilbert BW, Reichert M, Fletcher S. Strategies for the Management of Sepsis. AACN Adv Crit Care 2019; 30:5-11. [PMID: 30842067 DOI: 10.4037/aacnacc2019526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Brian W Gilbert
- Brian W. Gilbert is Emergency Medicine Clinical Pharmacy Specialist, Department of Pharmacy Services, Wesley Medical Center, 550 N Hillside Avenue, Wichita, KS 67214 . Michael Reichert is PGY-2 Critical Care Pharmacy Resident, Department of Pharmacy Services, and Suzanne Fletcher is Sepsis Education Coordinator, Department of Quality & Infection Prevention, Wesley Medical Center, Wichita, Kansas
| | - Michael Reichert
- Brian W. Gilbert is Emergency Medicine Clinical Pharmacy Specialist, Department of Pharmacy Services, Wesley Medical Center, 550 N Hillside Avenue, Wichita, KS 67214 . Michael Reichert is PGY-2 Critical Care Pharmacy Resident, Department of Pharmacy Services, and Suzanne Fletcher is Sepsis Education Coordinator, Department of Quality & Infection Prevention, Wesley Medical Center, Wichita, Kansas
| | - Suzanne Fletcher
- Brian W. Gilbert is Emergency Medicine Clinical Pharmacy Specialist, Department of Pharmacy Services, Wesley Medical Center, 550 N Hillside Avenue, Wichita, KS 67214 . Michael Reichert is PGY-2 Critical Care Pharmacy Resident, Department of Pharmacy Services, and Suzanne Fletcher is Sepsis Education Coordinator, Department of Quality & Infection Prevention, Wesley Medical Center, Wichita, Kansas
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Abstract
The Angiotensin II for the Treatment of Vasodilatory Shock (ATHOS-3) trial demonstrated the vasopressor effects and catecholamine-sparing properties of angiotensin II. As a result, the Food and Drug Administration has approved angiotensin II for the treatment of vasodilatory shock. This review details the goals of treatment of vasodilatory shock in addition to the history, current use, and recent research regarding the use of angiotensin II. An illustrative case of the use of angiotensin II is also incorporated for understanding the clinical utility of the drug.
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Affiliation(s)
- Brett J Wakefield
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8054, St Louis, MO 63110, USA
| | - Laurence W Busse
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Emory University School of Medicine, Emory St. Joseph's Hospital, 5665 Peachtree Dunwoody Road, Atlanta, GA 30342, USA
| | - Ashish K Khanna
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Center for Critical Care, Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue - G58, Cleveland, OH 44195, USA; Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Ahmed M, Habis S, Mahmoud A, Rutland C, Saeed R. Angiotensin II Use in Refractory Multisystem Shock: A Case Report. Cureus 2018; 10:e3665. [PMID: 30740284 PMCID: PMC6355300 DOI: 10.7759/cureus.3665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Distributive (vasodilatory) shock is common in patients admitted to the intensive care unit (ICU). Treating distributive shock presents a challenge, especially if a patient is tachyphylactic to commonly used vasopressors. This case report illustrates the use of a newly approved vasopressor in a patient with vasodilatory shock resulting from a motor vehicle injury. A 56-year-old man was brought to our emergency department (ED) hemodynamically unstable requiring aggressive resuscitation. The results of his evaluation were consistent with multisystem trauma for which he required intubation on arrival, and he received multiple units of blood and blood product via transfusion. The patient’s condition declined despite receiving multiple vasopressors in the ICU. A few days after admission, the patient developed ischemic bowel requiring surgical resection. While his chance of survival was believed to be dismal, the use of angiotensin II (ATII) as a last resort proved to be helpful.
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Affiliation(s)
- Mohamed Ahmed
- Surgery, Riverside Community Hospital / Envision Healthcare, Riverside, USA
| | - Saba Habis
- Internal Medicine, Riverside Community Hospital / Hospital Corporation of America, Riverside, USA
| | - Ahmed Mahmoud
- Surgery, Riverside Community Hospital / Envision Healthcare, Riverside, USA
| | - Cedric Rutland
- Internal Medicine, Riverside Community Hospital, Riverside, USA
| | - Rasha Saeed
- Surgery, Riverside Community Hospital / University of California, Riverside, USA
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